Provider Demographics
NPI:1699941096
Name:GRAVER, RYAN KEITH (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:KEITH
Last Name:GRAVER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FARLEY CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9252
Mailing Address - Country:US
Mailing Address - Phone:570-768-4455
Mailing Address - Fax:866-668-5729
Practice Address - Street 1:115 FARLEY CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9252
Practice Address - Country:US
Practice Address - Phone:570-768-4455
Practice Address - Fax:866-668-5729
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-06
Last Update Date:2010-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02342400122300000X
PADS0361791223E0200X
PADN0012091223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist